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. 2020 Feb;301(2):405-414.
doi: 10.1007/s00404-019-05390-8. Epub 2019 Nov 28.

Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG

Silvia M Lobmaier  1 , A Müller  2 , C Zelgert  3 , C Shen  4 , P C Su  4 , G Schmidt  2 , B Haller  5 , G Berg  6 , B Fabre  7 , J Weyrich  3 , H T Wu  4   8   9 , M G Frasch  10 , M C Antonelli  3   11
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Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG

Silvia M Lobmaier et al. Arch Gynecol Obstet. 2020 Feb.

Abstract

Purpose: Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic-pituitary-adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR.

Methods: Prospective case-control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2-3 months, was measured at birth.

Results: 538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother-child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0-169.2) versus 53.0 (34.4-105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18-0.85) versus 0.00 (- 0.49-0.18), p < 0.001].

Conclusion: Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied.

Trial registration: Clinical trial registration: NCT03389178.

Keywords: ANS; BPRSA; Bivariate phase-rectified signal averaging; FSI; Fetal autonomic nervous system; Fetal heart rate; Fetal stress index; PS; Prenatal stress.

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References

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